In movies, immediately after a mother gives birth, a nurse places a pristine newborn in her arms. In real life, however, babies usually look more Alien 3 than Pampers ad as they enter the world—their heads are misshapen, their faces resemble grumpy old men, and they’re covered in a white film. The traditional protocol has been to get them a sponge bath, stat.

But some doctors are now recommending new bathing procedures, and they may be gentler and safer for babies straight out of the birth canal. Here’s what parents need to know.

Wait to Bathe

That slick, creamy stuff all over your baby? It’s called vernix, and while it looks messy, it’s a protective layer that helps ward off infection and natural skin moisturizer. At UCHealth, a health system in Colorado, newborn baths are delayed for at least eight hours after birth in most cases. Doctors want to prolong the protective benefits of vernix, and also leave some amniotic fluid on the skin, which can promote better breastfeeding. According to Dr. Christine Gold, a physician at UCHealth, amniotic fluid is similar to colostrum, the initial breast milk that mothers produce.

Also, whisking babies away for bath and other non-critical procedures right after they’re born can rob parents of that important “golden hour” of skin-to-skin contact—the time when they can bond and establish a breastfeeding routine. Placing a naked newborn on a parent’s bare chest has been shown to help stabilize the baby’s body temperature, regulate their blood sugar levels and make their transition into the world less stressful.

Give a Swaddle Bath

Instead of the common sponge bath, which can be shocking for newborns who aren’t used to so many new temperatures, many doctors now recommend the swaddle immersion bath, in which a baby is bathed while wrapped in a swaddle. It’s soothing for infants, and something that parents can do at home. Here’s a how-to video from UCSF Benioff Children’s Hospital Oakland:

First, wrap your baby securely in a swaddle cloth with her arms folded up. Fill a tub with water that’s between 100-103 degrees Fahrenheit. Slowly lower your swaddled baby into the tub until the water is at chest and shoulder level. Then, starting with the legs, individually unswaddle each limb, wash it and rinse it. Do everything slowly and gently.

Other tips for bathing a newborn:

Wait at least 24 hours after circumcision to give your baby boy a bath.
Newborns don’t need to be bathed every day—once a week is enough.
Never put a baby into a tub when the water is still running.
Never, ever leave a baby in a bath unsupervised (if the doorbell rings, that person must wait).

Against heavy odds, the world’s tiniest and the fourth-smallest surviving infants have had normal childhood development, a new study shows, although the girls’ heights and weights still lag behind other kids the same age.

Little information is available to doctors and parents on how extremely low-birth-weight babies develop and grow as toddlers, school-age children, or into young adulthood. So a report like this offers a rare glimpse at the long-term health and growth of two of the world’s teeniest premature babies as they get older.

Rumaisa Rahman, a girl who holds the Guinness Book of World Records title of “World’s Smallest Surviving Baby,” is at her five-year follow-up doctor’s visit.

Born at just 26 weeks after her mother had severe preeclampsia, a serious condition involving high blood pressure and other abnormalities during pregnancy, Rumaisa was a twin. She weighed 9.2 ounces. She was roughly 9 inches long. Rumaisa spent 142 days in the hospital’s neonatal intensive care unit.

Madeline Mann is now a 22-year-old college senior. She was born at nearly 27 weeks into the pregnancy, also to a mother who had preeclampsia. She weighed roughly 9.9 ounces and was also about 9 inches long. Madeline was hospitalized for 122 days as a newborn before going home.

Her case is the first 20-year follow-up for one of the world’s smallest surviving infants reported in the medical literature.

Few babies born at birth weights of less than 14 ounces survive, so cases such as these are very rare. But the numbers of these “micro-preemies” who survive are on the rise.

The research appears in the Dec. 12 issue of Pediatrics.

Not Typical Outcomes

Both girls, who were born at the same Illinois hospital, showed normal language skills and hit normal milestones for walking and toilet training. Rumaisa’s movement skills — writing, grasping for toys, and getting dressed — are mildly delayed, while Madeline’s are described as normal.

Both girls remain small for their age for weight and height. Rumaisa is in first grade with an individualized education plan.

At 20, Madeline stood 4 feet, 7 inches and weighed about 65 pounds. Her growth has been consistently far below other girls her age.

“We tell parents of babies born this small not to expect their children to be super tall,” says researcher Jonathan Muraskas, MD.

Even so, he credits three main reasons for the girls’ relatively normal development. The first, says Muraskas, is that number of weeks of the pregnancy is much more important than birth weight for a child’s growth and brain development.

A second is that female preemies do better than males. “But we don’t know why,” says Muraskas, a professor of neonatal and perinatal medicine at Loyola University Medical Center in Maywood, Ill.

And a third reason is that both mothers were given steroids before birth. These medications help the baby’s lungs and brains mature faster and lower the risk of bleeding in the brain.

Muraskas points out that the two girls’ outcomes are not typical. Many micro-preemies either do not survive or grow up with disabilities from conditions such as cerebral palsy, mental retardation, and blindness.

While the researchers caution against considering their results as an expected outcome, it’s important for parents of these babies to recognize that there’s some hope.

“Good outcomes are possible even for the smallest babies,” says Edward Bell, MD, a neonatologist at the University of Iowa Children’s Hospital in Iowa City. He also says that for these tiny infants, the number of weeks spent inside the mother’s uterus affects their chances of survival more than their birth weight.

In 2000, Bell started a Tiniest Babies Registry when he realized he didn’t have good answers for parents’ questions about these babies who were born very premature.

Although information remains scarce, the registry has more than 100 babies who have survived weighing less than 14 ounces at birth.

“Most of them are doing pretty well,” Bell tells WebMD.

But this case report is not the norm, says Leslie Kerzner, MD, a neonatologist at Massachusetts General Hospital for Children in Boston. “[Rumaisa and Madeline] are two remarkable, isolated cases of survival of very low-birth-weight babies.”

It’s much more common for babies of this size to not survive or to have medical problems. “While these two girls may be the lucky ones, so many more suffer from hearing loss, vision, and movement problems, and [mental] delays,” Kerzner tells WebMD.

She says we still don’t know the long-term effects of the preemies’ long hospital stays. Nor do we know how much the babies’ discomfort and pain from their early-in-life medical care affects them later on.

Also, Kerzner says the report was not clear about how much special education or tutoring the girls need in school.

Research shows that 39-percent of Florida’s children born in 2008 were breastfed for the first six months, with only 20-percent breast fed for a year. That’s less than the two years recommended by the World Health Organization as well as the American Pediatric Association.

And, it’s partly because of stigmas or misconceptions associated with breastfeeding children.

“You hear, your breasts are going to sag, you hear some men don’t really want their or she might have the same view that this is a sexual thing, this is not a feeding mechanism, other ones are you’ve got a child that’s really spoiled, or here you’ve got a child who is a ‘booby-baby,’ who’s up under their mom too much,” remarked Quashier Flood-Strouble, a breastfeeding peer counselor and a certified lactation counselor in Tallahassee.

She says while the breastfeeding trend is starting to improve by educating more women, she feels there is one group of people that is getting lost in the breastfeeding process: men.

So, she and her brother, Mu-Tor Flood, created a movie aimed at helping fathers understand how integral they are to the breastfeeding process.

The locally-made film is called “Dads and Breastfeeding: The Official Guide for New Fathers.” Flood-Strouble says the influence fathers have shouldn’t just come into play when it comes to deciding whether to breastfeed.

For example, she says she had originally planned to have a natural birth with her first son, but due to complications, she later had to undergo a C-Section. Flood-Strouble says she had wanted to get her son breast feeding right away, but she couldn’t speak up because she was so tired from the ordeal and the drugs in her system. And, that’s when her husband Bruce Strouble stepped in:

“And, the nurses were actually trying to give him formula. I knew she wasn’t going to go for that. So, I had to be her mouthpiece basically,” said Strouble. “So, I had to go there and say no, no, no! She’s going to pump. They’re got her on the pump, and I’m running the colostrum [pump] down so that they can feed the baby. That’s just one way you help. Being there, being involved, and help her stay with it by just staying supportive.”

And, now Breastfeeding in the Strouble family is a tradition that’s carried down to their two other sons.

It’s also a practice that Bruce Strouble hopes to spread throughout the community. He and his group, Citizens for Sustainable Future Incorporated, recently held a panel discussion at the Leon County Health Department about the importance of breastfeeding. Included in the effort are the Florida Department of Health’s Office of Minority Health, Whole Child Leon, and the county’s health department.

Dykibra Gaskin is the nutrition educator at the Leon County health department who works with women, children, and infants. She says critics often turn the image of mothers feeding their babies in public into a sexual act because they believe the breast is indecently exposed. She says what fathers can do is to try and de-sexualize the breast by playing a more active role in defending it. Gaskin says in fact, she’s seen dads who do just that.

“They’re really cool about it. They’re like well, this is how she feeds our baby,” said Gaskin. “We have to be really nonchalant about it. This how we feed our baby. Bottles are not an option. So, men can play a role by defending his wife, defending his baby. Speak up! Don’t play a passive role!”

Doctor Esaias Lee, who practices Family Medicine at Capital Health Plan, says dads should also be prepared to help with the discomfort breastfeeding moms sometimes face when the baby’s mouth latches on, and encourage moms not to quit.

“As a dad, through your reading, you learn that you may need to get some dish clothes, maybe get them moist,” said Dr. Lee. “And, begin to help your soulmate, your wife or your significant other prepare her nipple to deal with some of this discomfort. So, it’s almost like you guys are in training camp as a couple. You’re trying to prepare yourself for this upcoming event so that you all can give your baby the best type of nourishment that it can receive.”

And, Dexter Harrell, a believer in breastfeeding, agrees. The 40-year-old man is the father of four children, including a 15-month old daughter, who is still breastfed. He says he and his wife struggled with breastfeeding his two oldest children, but things worked out for the last two. He says he’s glad he was able to help his wife through the process and points out the benefits are clear.

One of the biggest debates relating to the breastfeeding process is breastfeeding versus baby formula. While experts say some mothers find they don’t have to worry about their diet OR have to feed their babies as frequently because baby formula digests slower than breast milk, Harrell says breastfeeding, for him, wins hands down. He says, mostly because, it saved his family money and it’s very convenient.

Harrell says he encourages all fathers to get on board and involved in the breastfeeding process. He adds the movie is also a beneficial tool to help fathers regarding misconceptions or questions they might have about breastfeeding in general. Harrell and his family can also be seen in the “The Dads Official Guide to Breastfeeding” movie. To learn more about the movie, visit www.mqfproductions.com.